Clinical characterisation of women with persistent genital arousal disorder: the iPGAD-study.

Persistent Genital Arousal Disorder (PGAD) is a rare condition-mostly in women-where patients perceive prolonged genital arousal without any sexual desire or stimulation. Etiopathological considerations reach from peripheral to central issues over local disturbance of the pudendal nerve to neuropathy, psychosocial, and pharmacological theories. Since well controlled clinical studies about PGAD in conjunction with a mental and somatic health status are missing, this study is a detailed clinical investigation of PGAD patients compared to healthy controls. 26 women who fulfilled diagnostic criteria for PGAD were compared to 26 age matched healthy controls. Investigations included comparison of vegetative, gynaecological and sexual history, psychiatric features as well as a (neuro-)radiological, neurophysiological and gynaecological examination. Moreover, a detailed clinical characterisation of PGAD symptoms was performed. PGAD symptoms were mostly characterised as tingling or prickling and were permanently present. In over 80%, PGAD symptoms were located in the clitoris. Almost 70% reported radiations to other regions of the body. Most frequent trigger factors were tight clothes, mental stress, driving a car/bus/bicycle and sexual intercourse. Relieving factors were mainly distraction, relaxation, physical exercise, masturbation and swimming. In group comparisons, PGAD presented with significant higher rates of sexual dysfunctions, spontaneous orgasms, swelling of the genitals, extraordinary lubrication as well as higher rates in depression, agoraphobia, generalized anxiety disorder and lifetime panic disorder. Significantly more PGAD patients were diagnosed with restless legs symptoms. In contrast childhood traumatization, somatization disorder, suicidality, gynaecological as well as neurophysiological examination of the pudendal nerve were not different between the groups. MRI of the brain, pelvis and spinal cord was unsuspicious and incidental findings - including Tarlov cysts or pelvic venous congestion - were equally distributed among the groups. In summary, our study provides a careful characterization of women with PGAD highlighting a serious mental burden, most probably as a consequence of PGAD. With the current set of clinical investigations there was no evidence of a clear causal relationship to a specific clinical finding as it has been previously discussed. Future studies and additional techniques will have to further explore where and how in the peripheral or central nervous systems PGAD develops.

Genital warts and women's sexual challenges: is sexual compatibility possible? A qualitative study.

BACKGROUND: Genital warts, besides their importance as symptoms of sexually transmitted infections, can also threaten the sexual health of couples. The purpose of this study was to explore the sexual compatibility in women with active genital warts. METHODS: A qualitative study with a conventional content analysis approach in Tehran, Iran, from January 2019 to February 2020 was conducted on a purposeful sample of data saturation achieved after interviewing 14 women with genital warts, 2 couples and 3 dermatologists, 1 sexologist and 1 infectious disease specialist. Data were collected through unstructured interviews and analyzed using conventional content analysis approach. RESULTS: After data analysis 224 initial codes, 5 main categories "change in the frequency of sexual activity", "changing types of sexual intercourse", "protected sexual intercourse", "concealment of lesions", "focusing on personal hygiene by couples after sexual activity" and finally a central theme of "adaptation to challenges of sexual intercourse" were extracted. CONCLUSIONS: This study revealed the perceptions and experiences of women with active genital warts about the process of their sexual adaptation. The main concepts found in this study focus on challenges related to sexual intercourse. It seems that recognizing women's sexual adaptation challenges after getting genital warts may help them take effective and practical measures to improve their sexual compatibility and health.

Unconsummated marriage: a systematic review of etiological factors and clinical management.

BACKGROUND: Unconsummated marriage (UCM) is the inability of the heterosexual married couple to have penovaginal sexual intercourse. AIM: The study sought to systematically review current evidence regarding the etiological factors and clinical management of UCM. METHODS: A comprehensive bibliographic search on the MEDLINE, Scopus, Web of Science, and Cochrane Library databases was performed in June 2023. Studies were selected if they described married couples who never had sexual intercourse in case report or case series evaluating the related causes and/or management and reporting data with qualitative, quantitative, or mixed methods. The review was reported according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses) statement and registered in PROSPERO with ID CRD42023433040. RESULTS: A total of 27 studies including 1638 males and 1587 females were selected. Eight (29.6%) articles were case reports involving a single couple and 19 (70.4%) studies were case series. Mean Murad score was 4.1 (range, 1-8) showing low-intermediate overall study quality. All articles had a level of evidence of 4. Most of studies were conducted in Egypt (n = 5 [18.4%]), Israel (n = 4 [14.9%]), and the United States (n = 4 [14.9%]). The mean age of males and females varied between 24.2 and 37.6 years and from 21 to 27.4 years, respectively. The reasons for the medical visit that led to the diagnosis of UCM were inability to consummate in 23 (85.2%) studies, inability to conceive in 1 (3.7%) article, and mixed in 3 (11.1%) articles. The mean duration of UCM varied from 7 days to 3.5 years. Eight studies involving both men and women showed that vaginismus (8.4%-81%) and erectile dysfunction (10.5%-61%) were the most common causes of UCM. Three articles reported that 16.6% to 26% of all UCM cases were due to both male and female factors. Sildenafil, tadalafil, intracavernosal injection, penile plication, female genital reconstructive surgery, vaginal dilators, lubricants, psychosexual therapy, and sex education were the various treatment modalities in 27 studies to achieve consummation rate of 66.6% to 100%. STRENGTHS & LIMITATIONS: A strength is that this is the first systematic review covering the entire spectrum of UCM. Limitations comprised the low quality of most of the included articles and the large percentage of UCM cases probably not published. CONCLUSION: Erectile dysfunction and vaginismus are the most reported causes of UCM; however, a strong psychological component certainly underlies a significant number of cases. A multidisciplinary approach based on strategic integration of sex education, medical therapy, psychosexual support, and surgical treatment would seem the most suitable option to manage couples with UCM.

[Three surgical strategies for the treatment of intercourse-related hematuria in males: A summary of clinical experience].

OBJECTIVE: To summarize the clinical experience in the treatment of sexual intercourse-related hematuria in males using biopsy forceps, electrocoagulation and holmium laser cauterization. METHODS: From July 2018 to April 2022, we treated 11 male patients with intercourse-related hematuria using biopsy forceps, electrocoagulation and holmium laser cauterization. The patients ranged in age from 29 to 47 years, with clinical manifestations of gross hematuria, blood dripping from the urethral orifice or blood clots in the urine after sexual intercourse or erection, 3 with hemospermia, but none with pain. All the patients received urological imaging examination to exclude lesions in the upper urinary tract and bladder preoperatively. During the operation, varicose vessels were found around the posterior urethral verumontanum under the cystourethroscope in all the cases, 5 with active bleeding in the posterior varicose vessel. The 3 cases with hemospermia first underwent trans-prostatic utricle seminal vesiculoscopy. According to the range and number of varicose vessels, 5 of the patients were treated by electrocoagulation with the resectoscope, 2 by holmium laser cauterization and the other 4 with biopsy forceps to destroy the vascular tissue. After the operation, urinary catheters were retained for 3－7 days, abstinence lasted 30 days, and the patients were followed up for 6 months. RESULTS: The operations were successfully completed in all the cases, 10 with good prognosis and none with recurrence. Occasional postoperative hematuria and blood clots in the urine were observed in 1 of the patients treated by electrocoagulation under the resectoscope, with dysuria at 3 months after operation, who underwent repeated electrocoagulation and experienced no more recurrence thereafter. Different degrees of postoperative urethral irritation and gross hematuria were found in all the cases, which spontaneously disappeared within 1－4 weeks, with no such complications as ED, ejaculation pain, ejaculation difficulty and ejaculation weakness. CONCLUSION: In the absence of other genitourinary diseases, painless hematuria, blood clots in the urine or even dysuria in males after sexual intercourse can be considered as the results of possible varicose veins around the posterior urethral verumontanum, which can be treated satisfactorily by destroying the vascular tissue with biopsy forceps, electrocoagulation with the resectoscope or holmium laser cauterization according to the location, number and degree of varicose veins.

Prevalence and associated factors of early initiation of sexual intercourse among youth in Ethiopia: systematic review and meta-analysis.

BACKGROUND: Early sexual initiation refers to engaging in sexual activity at a young age, typically before the age of 18. Even though many studies have been conducted in Ethiopia, the result is inconsistent between studies. In the study area, the pooled prevalence and associated factors of early initiation of sexual intercourse among youth were not done before. Therefore, this study aimed to determine the pooled prevalence and associated factors of early initiation of sexual intercourse among Youth in Ethiopia. METHODS: This study used a systematic review and meta-analysis of studies conducted from 2008 to 2022, in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Cochrane Library, Hinari, and Google Scholar electronic databases were searched. The analysis was performed using STATA 17 software. Heterogeneity and publication bias were assessed using forest plots, I2, Cochran's Q statistics and Funnel plots, Egger test, and Begg rank tests respectively. Duval and Tweedie's 'trim and fill' method was also performed to adjust the pooled estimate. Pooled analysis was conducted using the inverse-variance fixed-effects model. RESULTS: A total of 10 articles were included in this systematic review and meta-analysis. The pooled prevalence of early initiation of sexual intercourse among youth in Ethiopia was 24.7% (95%CI: 10.4, 38.9). Being female (AOR = 3.57; 95% CI: 1.387, 5.743), having poor knowledge of HIV/AIDS prevention (AOR = 3.65; 95% CI: 1.981,5.309), alcohol use (AOR = 2.05; 95% CI: 1.415, 2.679), khat chewing (AOR = 3.03; 95% CI: 1.800, 4.254), Viewed pornographic film(AOR = 4.21, 95% CI: 2.135, 6.283), Cigarette smoking (AOR = 2.74; 95% CI: 2.102, 3.370) and Poor family controls (AOR = 4.39; 95% CI: 2.572, 6.199)were associated factors of early initiation of sexual intercourse. CONCLUSIONS: The pooled prevalence of early initiation of sexual intercourse among Youth in Ethiopia was high. Being female, poor knowledge of HIV/AIDS prevention, alcohol use, khat chewing, Viewing pornographic films, Cigarette smoking, and poor family controls were associated factors of early initiation of sexual intercourse. It is recommended that targeted interventions be put in place to address the high prevalence of early initiation of sexual intercourse among youth in Ethiopia. These interventions should focus on addressing the associated factors such as poor knowledge of HIV/AIDS prevention, alcohol use, khat chewing, viewing pornographic films, cigarette smoking, and poor family controls. It is important that these interventions are gender-sensitive and take into consideration the unique challenges faced by females in accessing sexual and reproductive health services.

Comparing pentafecta outcomes between nerve sparing and non nerve sparing robot-assisted radical prostatectomy in a propensity score-matched study.

Pentafecta (continence, potency, cancer control, free surgical margins, and no complications) is an important outcome of prostatectomy. Our objective was to assess the pentafecta achievement between nerve-spring and non-nerve-sparing robot-assisted radical prostatectomy (RARP) in a large single-center cohort. The study included 1674 patients treated with RARP between August 2009 and November 2022 to assess the clinical outcomes. Cox regression analyses were performed to evaluate the prognostic significance of RARP for pentafecta achievement, and 1:1 propensity score matching (PSM) was performed between the nerve-sparing and non-nerve-sparing to test the validity of the results. Pentafecta definition included continence, which was defined as the use of zero pads; potency, which was defined as the ability to achieve and maintain satisfactory erections or ones firm enough for sexual activity and sexual intercourse. The biochemical recurrence rate was defined as two consecutive PSA levels > 0.2 ng/mL after RARP; 90-day Clavien-Dindo complications ≤ 3a; and a negative surgical pathologic margin. The median follow-up period was 61.3 months (IQR 6-159 months). A multivariate Cox regression analysis demonstrated that pentafecta achievement was significantly associated with nerve-sparing (NS) approach (1188 patients) (OR 4.16; 95% CI 2.51-6.9), p < 0.001), unilateral nerve preservation (983 patients) (OR 3.83; 95% CI 2.31-6.37, p < 0.001) and bilateral nerve preservation (205 patients) (OR 7.43; 95% CI 4.14-13.36, p < 0.001). After propensity matching, pentafecta achievement rates in the NS (476 patients) and non-NS (476 patients) groups were 72 (15.1%) and 19 (4%), respectively. (p < 0.001). NS in RARP offers a superior advantage in pentafecta achievement compared with non-NS RARP. This validation study provides the pentafecta outcome after RARP associated with nerve-sparing in clinical practice.

Impact of female stress urinary incontinence and related treatments on the sexual function of male partners: a systematic review and meta-analysis.

BACKGROUND: No conclusions have been reached on whether female stress urinary incontinence (SUI) and related treatments affect male partners' sexual function. AIM: To assess the effects of female SUI and related treatments on male partners' sexual function. METHODS: A comprehensive search of the PubMed, Embase, Web of Science, Cochrane, and Scopus databases was performed up to September 6, 2022. Studies were included that investigated the effect of female SUI and related treatments on male partners' sexual function. OUTCOME: Male partners' sexual function. RESULTS: Of the 2294 citations identified, 18 studies with 1350 participants were included. Two studies assessed the effect of female SUI without treatment on male partners' sexual function, finding that partners had more erectile dysfunction, more sexual dissatisfaction, and less sexual frequency than partners of women without urinary incontinence. Seven studies directly assessed the effect of female SUI treatments on male partners' sexual function by surveying the male partners. Among these, 4 assessed transobturator suburethral tape (TOT) surgery; 1 assessed TOT and tension-free vaginal tape obturator surgery; and the remaining 2 assessed pulsed magnetic stimulation and laser treatment. Among the 4 TOT studies, 3 used the International Index of Erectile Function (IIEF). TOT surgery significantly improved the total IIEF score (mean difference [MD] = 9.74, P < .00001), along with erectile function (MD = 1.49, P < .00001), orgasmic function (MD = 0.35, P = .001), sexual desire (MD = 2.08, P < .00001), intercourse satisfaction (MD = 2.36, P < .00001), and overall satisfaction (MD = 3.46, P < .00001). However, the improvements in IIEF items may be of unclear clinical significance, as 4 points in the erectile function domain of the IIEF are typically defined as the minimal clinically important difference. In addition, 9 studies indirectly assessed the effect of female SUI surgery on male partners' sexual function by surveying patients with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. The results demonstrated no significant differences in erectile function (MD = 0.08, P = .40) or premature ejaculation (MD = 0.07, P = .54). CLINICAL IMPLICATIONS: The effects of female SUI and related treatments on male partners' sexual function were summarized for the first time, providing a reference for future clinical practice and scientific research. STRENGTHS AND LIMITATIONS: A limited number of studies that used various scales met the standardized eligibility criteria. CONCLUSION: Female SUI may affect male partners' sexual function, and female patients' anti-incontinence surgery does not appear to have a clinically significant improvement on the sexual function of their partners.

Sex-related quality of life after total laryngectomy for cancer.

OBJECTIVES: Analysis of the quality of sexual life after total laryngectomy (TL) for cancer. MATERIAL AND METHODS: The Cochrane, PubMed, Embase, ClinicalKey and Science Direct databases were searched using the keywords: "total laryngectomy, sexual function, sexual behavior, sexual complications, sexual dysfunction, sexuality, intimacy". The abstracts of 69 articles were read by two of the authors and 24 articles were selected. The main endpoint was the impact of impairment of quality of sexual life after TL for cancer and the methods used to assess this. The secondary endpoints were the type of sexual impairment, associated variables and their treatment. RESULTS: The study population consisted of 1511 TL patients aged 21 to 90 years, with a male/female sex ratio of 7.49. One of the 7 validated Likert scales was used in 79% of the articles to evaluate impairment of sexual quality of life. Impaired quality of sexual life was reported by 47% of patients on average (range, 5-90%). Erectile and ejaculatory function and ejaculatory behavior of male patients decreased after TL. Other impairments comprised decreases in libido, frequency of sexual intercourse and satisfaction. Tracheostomy, advanced disease stage, young age and associated depression were factors for impairment. In all, 23% of patients reported lack of postoperative support in this area. CONCLUSION: The quality of sexual life is severely impacted by TL for cancer. The present data are a source of information and should be taken into account before carrying out TL. A common information tool needs to be developed. There is patient demand for improved management of sexuality.

Yann Andréa, "une lettre que je continue de vous écrire / Uma carta que eu continuo te escrevendo / Yann Andréa, "a letter I keep writing to you"

Jeune étudiant en philosophie à Caen, Yann Andréa qui s'appelle encore Yann Lemée, découvre l'écriture de Marguerite Duras, instantanément galvanisé par l'expérience, il se met à lui écrire, presque tous les jours, parfois plusieurs fois par jour, par paquets, sans attente de réponse. Touchée par la puissance de Yann, Duras lui répond, lui dédie une œuvre et finit par partager sa vie avec lui. Il s'agit d'un amour qui n'est pas habillé par le fantasme mais qui est resserré autour d'un point de réel, l'écriture. Sophie Marret-Maleval prend le couple Duras/Andréa en exemple pour illustrer par la négative l'inexistence du rapport sexuel : la fonction d'agrafe de l'amour, qui s'écrit S1-a, serait réalisée dans ces moments d'écriture à travers leurs positions subjectives respectives : M. Duras en place de produire les S1 et Y. Andréa au lieu de l'objet

Jovem estudante de filosofia em Caen, Yann Andréa, então conhecido como Yann Lemée, descobre a escrita de Marguerite Duras e, instantaneamente galvanizado pela experiência, começa a escrever para ela, quase todos os dias, às vezes várias vezes ao dia, em pacotes, sem esperar por uma resposta. Tocada pela força de Yann, Duras lhe responde, dedica uma obra a ele e acaba compartilhando sua vida com ele. Trata-se de um amor que não é vestido pelo fantasma, mas que é apertado em torno de um ponto de realidade, a escrita. Sophie Marret-Maleval utiliza o casal Duras/Andréa como exemplo negativo para ilustrar a inexistência da relação sexual: a função de ligação do amor, expressa como S1-a, é realizada nesses momentos de escrita através de suas posições subjetivas respectivas: M. Duras no lugar de produzir os S1 e Y. Andréa no lugar do objeto.

A young philosophy student in Caen, Yann Andréa, still known as Yann Lemée, discovers the writing of Marguerite Duras, instantly galvanized by the experience, begins to write to her, almost every day, sometimes several times a day, in packages, without expecting a response. Touched by Yann's power, Duras replies to him, dedicates a work to him, and eventually shares her life with him. This is a love that is not clothed in fantasy but is centered around a point of reality: writing. Sophie Marret-Maleval uses the Duras/Andréa couple as a negative example to illustrate the absence of the sexual relationship: the function of bonding that love performs, expressed as S1-a, is realized in these moments of writing through their respective subjective positions: M. Duras in the position of producing the S1 and Y. Andréa in the place of the object

Yann Andréa, "uma carta que eu continuo te escrevendo" / Yann Andréa, "une lettre que je continue de vous écrire" / Yann Andréa, "a letter I keep writing to you"

Jovem estudante de filosofia em Caen, Yann Andréa, então conhecido como Yann Lemée, descobre a escrita de Marguerite Duras e, instantaneamente galvanizado pela experiência, começa a escrever para ela, quase todos os dias, às vezes várias vezes ao dia, em pacotes, sem esperar por uma resposta. Tocada pela força de Yann, Duras lhe responde, dedica uma obra a ele e acaba compartilhando sua vida com ele. Trata-se de um amor que não é vestido pelo fantasma, mas que é apertado em torno de um ponto de realidade, a escrita. Sophie Marret-Maleval utiliza o casal Duras/Andréa como exemplo negativo para ilustrar a inexistência da relação sexual: a função de ligação do amor, expressa como S1-a, é realizada nesses momentos de escrita através de suas posições subjetivas respectivas: M. Duras no lugar de produzir os S1 e Y. Andréa no lugar do objeto

eune étudiant en philosophie à Caen, Yann Andréa qui s'appelle encore Yann Lemée, découvre l'écriture de Marguerite Duras, instantanément galvanisé parl'expérience, il se met à lui écrire, presque tous les jours, parfois plusieurs fois par jour, par paquets, sans attente de réponse. Touchée par la puissance de Yann, Duras lui répond, lui dédie une œuvre et finit par partager sa vie avec lui. Il s'agit d'un amour qui n'est pas habillé par le fantasme mais qui est resserré autour d'un point de réel, l'écriture. Sophie Marret-Maleval prend le couple Duras/Andréa en exemple pour illustrer par la négative l'inexistence du rapport sexuel : la fonction d'agrafe de l'amour, qui s'écrit S1-a, serait réalisée dans ces moments d'écriture à travers leurs positions subjectives respectives : M. Duras en place de produire les S1 et Y. Andréa au lieu de l'objet

A young philosophy student in Caen, Yann Andréa, still known as Yann Lemée, discovers the writing of Marguerite Duras, instantly galvanized by the experience, begins to write to her, almost every day, sometimes several times a day, in packages, without expecting a response. Touched by Yann's power, Duras replies to him, dedicates a work to him, and eventually shares her life with him. This is a love that is not clothed in fantasy but is centered around a point of reality: writing. Sophie Marret-Maleval uses the Duras/Andréa couple as a negative example to illustrate the absence of the sexual relationship: the function of bonding that love performs, expressed as S1-a, is realized in these moments of writing through their respective subjective positions: M. Duras in the position of producing the S1 and Y. Andréa in the place of the object

Gynecological Care Among Brazilian Women Who Have Sex with Women: A Respondent-Driven Sampling Study.

Purpose: This study aimed to describe the gynecological care provided to Brazilian women who have sex with women (WSW). Methods: Respondent-driven sampling was used to recruit Brazilian WSW. The survey questions, concerning gynecological care, were designed in Portuguese by medical professionals, medical students, and LGBTQIA+ community members, including the authors. The statistical analyses were weighted to account for the likelihood of recruitment. Results: From January to August of 2018, 299 participants were recruited in 14 recruitment waves. The mean age of the WSW was 25.3 years. Most (54.9%) identified as lesbian and had been involved in past-year sexual intercourse mainly with cisgender women (86.1%). The WSW also reported having sex with cisgender men (22.2%), transgender men (5.3%), nonbinary people (2.3%), and transgender women (5.3%) in the last year. More than a quarter of the WSW did not have regular appointments with a gynecologist: 8.0% (95% confidence interval [CI] = 4.2-11.6) and 19% (95% CI = 12.8-25.2) stated that they had never gone to the gynecologist or they had only gone for emergencies, respectively. Almost one-third had never had cervical cancer screening (cervical cytology, Pap test or Pap smear). Most women justified avoiding the test because they felt healthy, thought it would hurt, or feared a health professional might mistreat them. Conclusion: Gynecologists should avoid heteronormative assumptions, inquire about sexual practices, orientation, and identity separately, and provide Pap tests as advised to WSW.

Identifying causal associations between early sexual intercourse or number of sexual partners and major depressive disorders: A bidirectional two-sample Mendelian randomization analysis.

BACKGROUND: Early sexual intercourse and a greater number of sexual partners have been proved associated with depression. However, the causality of these associations is not clear. METHODS: To unveil the causal associations between sexual factors and major depression disorder (MDD). The bidirectional, two-sample Mendelian randomization (MR) study was conducted, which used genetic variants associated with two sexual factors (age first had sexual intercourse, n = 406,457; lifetime number of sexual partners, n = 378,882) and MDD (n = 500,199) from the largest genome-wide association studies (GWASs) conducted by the UK biobank and the Psychiatric Genomics Consortium. The two-step MR analysis was applied to assess mediation. The Genetic predictors for five risky behaviors were also obtained from the most up-to-date GWAS conducted by the UK Biobank (ever self-harmed: 117,733; ever attempted suicide: 4933; psychoactive substance abuse, alcohol use, and tobacco use: 463,010). RESULTS: MR analysis indicated a risky causal effect of age first had sexual intercourse (OR = 0.720, 95 % CI: 0.661-0.784, P = 2.45 × 10-14) and lifetime number of sexual partners (OR = 1.656, 95 % CI: 1.356-2.022, P = 7.46 × 10-7) on MDD. Mediation analysis showed the effects were mediated by tobacco use, with a proportion of 34.20 % on age first had sexual intercourse and 22.94 % on lifetime number of sexual partners separately. LIMITATIONS: The overlap of participants in different traits and unclear gender. CONCLUSIONS: Robust genetic evidence indicated that premature sexual intercourse and more sexual partners were risks for MDD. Risky behaviors, especially the tobacco use, mediated this effect.

Gynecological Cancer Survivors' Experiences of Dyspareunia and Factors Influencing Care-Seeking Behavior: A Qualitative Study.

Pain during sexual intercourse, also called dyspareunia, affects most women after treatment for gynecological cancer. Previous work adopted a biomedical approach to depict dyspareunia in this population, which provided a narrow perspective of this condition. Taking into account women's experiences of dyspareunia and the factors influencing their care-seeking behaviors would provide insight to improve care in the context of gynecological cancer. The aim of this study was to describe gynecological cancer survivors' experiences of dyspareunia and factors influencing care-seeking behavior. A qualitative study was performed with 28 gynecological cancer survivors with dyspareunia. Individual telephone interviews were conducted based on the Common-Sense Model of Self-Regulation. Interviews were recorded and transcribed for analysis using the interpretative description framework. Concerning their experience, participants reported the oncological treatments as the primary cause of dyspareunia. Loss of libido, lower vaginal lubrication, and smaller vaginal cavity were described as being linked with dyspareunia. Women explained how dyspareunia and these changes had led them to engage less in, and even interrupt, sexual activity. They expressed that they were distressed, felt less of a woman, and experienced low control and/or self-efficacy. Regarding the factors influencing women's care-seeking behaviors, participants emphasized that they were provided with insufficient information and support. Balancing priorities, denial or reluctance, misbeliefs, resignation and acceptance, and negative emotions were reported as barriers, whereas acknowledgement of sexual dysfunction, desire for improvement, awareness of treatment possibilities, willingness to undertake treatment and treatment acceptability were reported as facilitators to seeking care. Findings suggest that dyspareunia is a complex and impactful condition after gynecological cancer. While this study highlights the importance of alleviating the burden of sexual dysfunction in cancer survivors, it identified factors that should be considered in the provision of services to improve care.

Sexual health and sexual well-being of women with Mayer-Rokitansky-Kuester-Hauser syndrome after vaginal reconstruction: a qualitative analysis.

BACKGROUND: Contradictory findings on sexual health in women with Mayer-Rokitansky-Kuester-Hauser syndrome (MRKHS) after vaginal reconstruction point toward the need for more profound assessment of this subject, particularly as it is still unclear what constitutes sexual well-being, especially genital self-image or sexual self-esteem, in women with MRKHS and neovagina. AIM: The aim of this qualitative study was to assess individual sexual health and sexual well-being in the context of MRKHS after vaginal reconstruction, with an emphasis on genital self-image, sexual self-esteem, sexual satisfaction, and coping with MRKHS. METHODS: Qualitative semistructured interviews were conducted with women with MRKHS after vaginal reconstruction (n = 10) with the Wharton-Sheares-George surgical method and a matched control group without MRKHS (n = 20). Women were surveyed about their previous and current sexual activities, perception of and attitudes toward their genitals, disclosure to others, coping with the diagnosis, and perception of surgery. Data were analyzed through qualitative content analysis and compared with the control group. OUTCOMES: The primary outcomes of the study were major categories, such as sexual satisfaction, sexual self-esteem, genital self-image, and dealing with MRKHS, as well as subcategories related to the content analysis. RESULTS: Although half the women in the present study indicated that they were coping well with their condition and were satisfied with sexual intercourse, most felt insecure about their neovagina, were cognitively distracted during intercourse, and showed low levels of sexual self-esteem. CLINICAL IMPLICATIONS: A better understanding of expectations and uncertainties regarding the neovagina might help professionals to support women with MRKHS after vaginal reconstruction to increase sexual well-being. STRENGTHS AND LIMITATIONS: This is the first qualitative study focusing on individual aspects of sexual well-being, especially sexual self-esteem and genital self-image, in women with MRKHS and neovagina. The qualitative study indicates good interrater reliability and data saturation. The limitations of this study include the inherent lack of objectivity resulting from the method but also the fact that all the patients had a particular surgical technique, consequently resulting in limited generalizability of these findings. CONCLUSIONS: Our data indicate that integrating the neovagina into the genital self-image is a prolonged process that is essential for sexual well-being and should thus be the focus of sexual counseling.

Shared sex hormone metabolism-related gene prognostic index between breast and endometrial cancers.

Aims: As sex hormone-dependent tumors, it remains to be clarified whether there is a common genetic signature and its value between breast and endometrial cancers. The aim of this study was to establish the shared sex hormone metabolism-related gene prognostic index (SHMRGPI) between breast and endometrial cancers and to analyze its potential role in the therapeutic and prognostic assessment of endometrial cancers. Methods: Using transcriptome data from TCGA, tumor-associated gene modules were identified by weighted gene co-expression network analysis, and the intersection of module genes with female sex hormone synthesis and metabolism genes was defined as sex hormone metabolism-related gene. SHMRGPI was established by the least absolute shrinkage and selection operator and Cox regression. Its prognostic value of patients with endometrial cancer was validated, and a nomogram was constructed. We further investigated the relationship between SHMRGPI groups and clinicopathological features, immune infiltration, tumor mutation burden, and drug sensitivity. Results: A total of 8 sex hormone metabolism-related gene were identified as key genes for the construction of prognostic models. Based on SHMRGPI, endometrial cancer patients were divided into high and low SHMRGPI groups. Patients in the low SHMRGPI group had longer overall survival (OS) compared with the high group (P< 0.05). Furthermore, we revealed significant differences between SHMRGPI groups as regards tumor immune cell infiltration, somatic mutation, microsatellite instability and drug sensitivity. Patients with low SHMRGPI may be the beneficiaries of immunotherapy and targeted therapy. Conclusions: The SHMRGPI established in this study has prognostic power and may be used to screen patients with endometrial cancer who may benefit from immunotherapy or targeted therapy.

Association of high-risk sexual behaviours with sexually transmitted infections among men who have sex with men living with HIV.

OBJECTIVES: To explore different sexual behaviours as risk factors for STI among men who have sex with men (MSM) living with HIV. METHODS: This is a cross-sectional study on MSM living with HIV followed at the Infectious Diseases Unit of San Raffaele Hospital, Milan, with at least one diagnosis of gonorrhoea, syphilis, chlamydia or anal human papilloma virus (HPV), between July 2016 and February 2021. We conducted a survey on high-risk sexual behaviours with regard to (1) mean number of partners per month, (2) estimated percentage of condom use and (3) most frequent type of sexual intercourse during 2016-2021. Data on these variables were grouped as follows: (1a) ≤5 vs >5, (1b) >10 vs ≤10, (2a) 0% vs >0%, (2b) ≤50% vs >50%, (2c) 100% vs <100%, (3a) ≥50% vs <50% receptive, (3b) 100% vs <100% insertive, and (3c) 100% vs <100% receptive. A high-risk group was defined as >5 partners, <100% use of condom and ≥50% receptive intercourse. Univariate logistic regressions were applied to assess the association between sexual behaviours and the risk of each STI. RESULTS: Out of 1051 MSM with at least one STI diagnosis, 580 (55%) answered the survey. The risk of chlamydia was lower among individuals with ≤5 partners (≤5 partners vs >5 partners: OR=0.43, 95% CI 0.28 to 0.66, p=0.001) and among those using condoms more frequently (≤50% use of condom vs >50% use of condom: OR=1.55, 95% CI 1.06 to 2.27, p=0.025; 100% vs <100%: OR=0.35, 95% CI 0.20 to 0.59, p=0.001). Individuals using condoms more frequently also had lower risk of gonorrhoea (100% use of condom vs <100% use of condom: OR=0.37, 95% CI 0.17 to 0.79, p=0.011). The risks of chlamydia (OR=3.07, 95% CI 1.92 to 4.90, p<0.001) and gonorrhoea (OR=2.05, 95% CI 1.12 to 3.75, p=0.020) were higher among individuals belonging to the high-risk group. CONCLUSIONS: Chlamydia and gonorrhoea are more likely associated with high-risk sexual behaviours than syphilis and anal HPV among MSM living with HIV.

Sexualidade como fator associado à qualidade de vida da pessoa idosa / Sexualidad como factor asociado a la calidad de vida de las personas mayores / Sexuality as a factor associated with the quality of life of the elderly

Resumo Objetivo analisar a associação entre as vivências em sexualidade com as variáveis biossociodemográficas e a qualidade de vida de pessoas idosas. Métodos estudo transversal, desenvolvido com 1.922 pessoas idosas brasileiras, cujos dados foram coletados por meio de web survey. Utilizaram-se três instrumentos para a obtenção dos dados biossociodemográficos, da sexualidade e da qualidade de vida. A análise foi realizada com os testes de Mann-Whitney, Kruskal-Wallis, correlação de Spearman e regressão linear multivariada, com método de entrada "inserir", adotando Intervalo de Confiança de 95%. Resultados a avaliação geral da sexualidade esteve associada fortemente com estado civil (p<0,001); religião (p=0,001); não ter filhos (p<0,001); orientação sexual (p=0,008) e recebimento de orientações sobre sexualidade pelos profissionais de saúde (p=0,002). A sexualidade correlacionou-se de forma positiva e com diferentes magnitudes com todas as facetas de qualidade de vida (p<0,001). A análise de regressão demonstrou que todas as dimensões da sexualidade permaneceram associadas, positivamente, com qualidade de vida: ato sexual [β=0,154; IC95%=0,083-0,225; p<0,001]; relações afetivas [β=0,335; IC95%=0,263-0,407; p<0,001] e adversidades física e social [β=1,388; IC95%=1,206-1,571; p<0,001]. Conclusão e implicações para a prática: a sexualidade associou-se, significativamente, com algumas variáveis biossociodemográficas e esteve correlacionada, positivamente, com a qualidade de vida das pessoas idosas investigadas.

Resumen Objetivo analizar la asociación entre experiencias en sexualidad con las variables biosociodemográficas y la calidad de vida de los adultos mayores. Métodos estudio transversal desarrollado con 1.922 ancianos brasileños, cuyos datos fueron recolectados a través de una encuesta web. Se usaron tres instrumentos para obtener datos biosociodemográficos, de sexualidad y de la calidad de vida. El análisis se realizó mediante las pruebas de Mann-Whitney, Kruskal-Wallis, correlación de Spearman y regresión lineal multivariada, con método de entrada "ingresar", adoptando un Intervalo de Confianza del 95%. Resultados la evaluación general de la sexualidad se asoció fuertemente con el estado civil (p <0,001); religión (p = 0,001); no tener hijos (p <0,001); orientación sexual (p = 0,008) y recibir orientación sobre sexualidad por parte de profesionales de la salud (p = 0,002). La sexualidad se correlacionó positivamente y con diferentes magnitudes con todas las facetas de la calidad de vida (p <0,001). El análisis de regresión mostró que todas las dimensiones de la sexualidad permanecieron asociadas positivamente con la calidad de vida: relaciones sexuales [β = 0,154; IC95% = 0,083-0,225; p <0,001]; relaciones afectivas [β = 0,335; IC95% = 0,263-0,407; p <0,001] y adversidades físicas y sociales [β = 1,388; IC95% = 1,206-1,571; p <0,001]. Conclusión e implicaciones para la práctica la sexualidad se asoció significativamente con algunas variables biosociodemográficas y se correlacionó positivamente con la calidad de vida de los ancianos investigados.

Abstract Objective to analyze the association between experiences of sexuality with bio-socio-demographic variables and quality of life of elderly people. Methods cross-sectional study, developed with 1,922 Brazilian elderly people, whose data were collected through a web survey. Three instruments were used to obtain bio-socio-demographic data, sexuality and quality of life. The analysis was carried out with the Mann-Whitney, Kruskal-Wallis, Spearman correlation and multivariate linear regression tests, with the "insert" input method, adopting a 95% confidence interval. Results the overall assessment of sexuality was strongly associated with marital status (p<0.001); religion (p=0.001); not having children (p<0.001); sexual orientation (p=0.008) and receiving guidance on sexuality from health professionals (p=0.002). Sexuality correlated positively and with different magnitudes with all facets of quality of life (p<0.001). Regression analysis demonstrated that all dimensions of sexuality remained positively associated with quality of life: sexual act [β=0.154; 95%CI=0.083-0.225; p<0.001]; affective relationships [β=0.335; 95%CI=0.263-0.407; p<0.001] and physical and social adversity [β=1.388; 95%CI=1.206-1.571; p<0.001]. Conclusion and implications for practice sexuality was significantly associated with some bio-socio-demographic variables and positively correlated with the quality of life of the elderly people investigated.

Percepções e expectativas de homens trans acerca dos relacionamentos afetivo-sexuais pós-transição / Trans men's perceptions and expectations of post-transition affective-sexual relationships / Percepciones y expectativas de los hombres trans sobre las relaciones afectivo-sexuales después de la transición

As identidades transmasculinas ganharam visibilidade social e acadêmica no Brasil a partir de 2010, contudo, as questões subjetivas dos homens trans ainda são pouco debatidas, em particular temas associados aos relacionamentos afetivos na experiência desses sujeitos. Este estudo qualitativo tem por objetivo identificar as percepções e expectativas dos homens trans acerca dos relacionamentos afetivo-sexuais no cenário pós-transição de gênero. Participaram da pesquisa 15 homens transexuais hormonizados, com idades entre 20 e 41 anos. A coleta de dados foi realizada por meio de entrevista semiestruturada nas modalidades presencial e on-line. Empregou-se análise temática reflexiva, que resultou em dois temas analíticos. Os resultados apontam que os homens trans, ao contrário de suas expectativas iniciais, percebem que tiveram menos oportunidades de relacionamentos afetivo-sexuais depois de sua transição de gênero. Os participantes atribuem essa dificuldade especialmente ao fato de não terem se submetido à cirurgia de redesignação sexual. O desconforto é acentuado por sua materialidade corpórea divergente da cisnormatividade, sistema regulador que associa pessoas pertencentes ao gênero masculino à presença de um pênis. Outra fonte de desconforto é o repúdio social, que alimenta a abjeção, exotização e fetichização dos corpos transmasculinos. Também são descritas as especificidades do relacionamento dos homens trans com mulheres cisgênero, heterossexuais e lésbicas. Os resultados evidenciam que a fixação persistente no genital, como referente e signo determinante do gênero e da sexualidade, modula e regula a busca e o encontro de parceira(o) íntima(o).(AU)

Transmasculine identities have gained social and academic visibility in Brazil since 2010, but subjective issues, especially those associated with affective relationships, are still little discussed. This qualitative study sought to identify trans men's perceptions and expectations regarding post-transition affective-sexual relationships. A total of 15 transsexual men undergoing hormone therapy, aged between 20 and 41 years, participated in the research. Data were collected by means of in-person and online semi-structured interviews and analysed using reflexive thematic analysis, which resulted in two analytical themes. Results show that trans men, differently from their initial expectations, perceive fewer opportunities for affective-sexual relationships after their gender transition. The participants attribute this difficulty, especially, to the fact that they have not undergone sexual reassignment surgery. Discomfort isaccentuated by their bodily materiality diverging from cisnormativity, the regulatory system that associates people belonging to the male gender with the presence of a penis. Another source of discomfort is the social repudiation, which reinforces the abjection, exoticization, and fetishization of transmasculine bodies. The specifics of trans men's relationships with cisgender, heterosexual, and lesbian women are also described. The results show that the persistent fixation on the genital, as a referent and determinant sign of gender and sexuality, modulates and regulates the search for and encounter of intimate partners.(AU)

Las identidades transmasculinas han ganado visibilidad social y académica en Brasil desde 2010, sin embargo, las cuestiones subjetivas de los hombres trans son aún poco discutidas, en particular las cuestiones asociadas a las relaciones afectivas en la experiencia de estos sujetos. Este estudio cualitativo tiene como objetivo identificar las percepciones y expectativas de los hombres trans sobre las relaciones afectivo-sexuales después de la transición de género. Participaron en la investigación 15 hombres transexuales hormonados, de edades comprendidas entre los 20 y los 41 años. La recopilación de datos se realizó mediante una entrevista semiestructurada en las modalidades presencial y en línea. Se realizó un análisis temático reflexivo, que dio como resultado dos temas analíticos. Los resultados muestran que los hombres trans, al contrario de sus expectativas iniciales, perciben que han tenido menos oportunidades de relaciones afectivo-sexuales después de su transición de género. Los participantes atribuyen esta dificultad especialmente al hecho de no haberse sometido a cirugía de reasignación sexual. La incomodidad se acentúa por su materialidad corpórea divergente de la cisnormatividad, un sistema normativo según el cual las personas pertenecientes al género masculino deben tener pene. Otra fuente de malestar es el repudio social, que alimenta la abyección, la exotización y la fetichización de los cuerpos transmasculinos. También se describen las especificidades de las relaciones de los hombres trans con las mujeres heterosexuales, cisgénero y lesbianas. Los resultados muestran que la persistente fijación en los genitales, como referente y signo determinante del género y la sexualidad, modula y regula la búsqueda y el encuentro de parejas íntimas.(AU)

O Um e a função do sexo segundo a psicanálise / El Uno y la función del sexo según el psicoanálisis / The One and the function of sex according to psychoanalysis

RESUMO Segundo a ambiguidade constitutiva do Um que Lacan promove a partir da lógica e da matemática nos seminários O saber do psicanalista e ... ou pior, entre 1971 e 1972, o artigo busca fundamentar a teoria da sexuação desenvolvida nesse período e esclarecer que tal conceituação retoma a subversão freudiana do polimorfismo pulsional. Se a pulsão não tem qualquer determinação instintual quanto a seu objeto, constata-se que esse mesmo equívoco se deslinda como impossibilidade de proporção e relação sexual [rapport sexuel] para o ser falante, que se posiciona gramaticalmente na estrutura da linguagem a partir desse impasse. Nesse sentido, a bifididade do Um, entre conjunto e elemento, mesmidade e diferença, particularidade e universalidade, ex-sistência e relatividade, real e simbólico, reescreve a diferença (sexual) conforme a psicanálise. O sexo, portanto, é a própria ausência de qualquer referência que não seja a opacidade de princípio do significante, é a evasão fundamental do ser à verdade.

RESUMEN Basado en la ambigüedad constitutiva del Uno que Lacan promueve desde la lógica y de la matemática en los seminarios O saber do psicanalista e ...ou pior, entre 1971 y 1972, el artículo busca apoyar la teoría de la sexuación desarrollada en ese período y aclarar que tal conceptualización reanuda la subversión freudiana del polimorfismo de la pulsión. Si la pulsión no tiene ninguna determinación instintiva en cuanto a su objeto, parece que este mismo malentendido se revela como la imposibilidad de la proporción y la relación sexual [rapport sexuel] para el ser hablante, que se posiciona gramaticalmente en la estructura del lenguaje desde esta cuestión. Así, la bifidez del Uno, entre conjunto y elemento, igualdad y diferencia, particularidad y universalidad, ex-sistencia y relatividad, real y simbólico, reescribe la diferencia (sexual) según el psicoanálisis. El sexo, por lo tanto, es la ausencia misma de cualquier referencia que no sea la opacidad de principio del significante, es la evasión fundamental del ser de la verdad.

ABSTRACT Based on the constitutive ambiguity of the One that Lacan promotes from logic and mathematics in the seminaries O saber do psicanalista e ...ou pior, between 1971 and 1972, the article seeks to support the theory of sexuation developed in that period and clarify that such conceptualization resumes the Freudian subversion of the drive polymorphism. If the drive does not have any instinctual determination as to its object, it appears that this same misunderstanding is revealed as the impossibility of proportion and sexual relationship [rapport sexuel] for the speaking being, who grammatically positions themselves in the structure of language from this impasse. Thus, the bifidity of the One, between set and element, sameness and difference, particularity and universality, ex-sistence and relativity, real and symbolic, rewrites the (sexual) difference according to psychoanalysis. Sex, therefore, is the very absence of any reference other than the constitutive opacity of the signifier, it is the fundamental evasion of the being from the truth.